Therapist Sadness, Guilt and Longing After Client Leaves Therapy

If we therapists are any good at our jobs, we become very attached to many of our clients.  We feel pain when they’re experiencing shame,  sadness and fear.  We’re  pleased when they feel proud about  dealing effectively with a person or issue with which they’ve had difficulty .  We are joyful when they feel exhilarated about  some significant achievement in their job or profession or sport.  We  feel pity for them and angry at those who have mistreated, abused and  wronged them  And our own self-esteem can zoom when they express affection and appreciation to us for helping them.

But unlike other intimate bonds, our relationship with them is not reciprocal and it ends when they leave therapy, hopefully having grown and worked through some important issues in their lives.

I myself have often felt sad, even grief,  when a long-term client has terminated, and a longing to know what has happened to them later on.  I occasionally will receive a phone call,  email or letter after they have terminated, letting me know how they are doing, and I always feel grateful to them for the communication.  And I must admit I am tempted, sometimes, to contact them myself when I think about them.  I hardly ever do that because I know I would be doing that for me, not for them.  Even when the therapy has been very successful,  they may associate me with a difficult time in their lives and don’t want to be reminded of it.  Or they may think that I’m trying to get them to come back into treatment.  Or, God forbid,  see me as a needy person!

A few clients I have contacted after they have left, but these are the ones whom I sense will appreciate my doing so. Often, they also are therapists.  But I hardly ever succumb to the urge to contact an ex-client .  And I certainly don’t presume that we will have a friendship outside of the therapy.

One young man I felt very fond of and with whom the therapy was very effective was a young man who had followed his girlfriend to LA while she attended summer school.  She had told him that she was very ambivalent about their relationship and wanted to take a break from it.  He was depressed and decided to enter treatment.   We worked through the Summer and I helped him to resolve many issues he had that had been due to familial issues, mostly with an overbearing, domineering father.  He was a big guy, had been a very successful football player in college, but his chief interest was in poetry, an activity  his father did not approve of at all.  We accomplished quite a bit and, in the Fall, he  left to return to the East Coast.  He came back to LA the next Summer and we resumed our work.  He resolved his issue with his girl friend and had individuated himself from his father. He learned, when the Summer was almost over,  that he had been accepted in the graduate program at a top Ivy League university for a full, four-year scholarship.   By the time he had to leave for graduate school, we both felt he had finished his work with me and that the work had been very successful.  We said our goodbyes and expressed our appreciations of each other.   When he left my office for the last time, I cried, partly in sadness that I probably wouldn’t see him again and also  gratitude that I had been graced with  such a deep relationship.   But somehow I don’t feel unfinished with him.  I have confidence he is having a very successful career and life.  I also think that my allowing myself to express my feelings about saying goodbye to him helped me be complete.

I do wish I could work with some clients again because I realized after they terminated treatment there was some important issue I missed and think that I could now be even more helpful to them than I was when we were meeting.  Although I know that I did the best for them in view of who I was then as a therapist,  I feel sad thinking I failed them in some important way. For example, a man I saw in long-term therapy when I was still practicing in LA, made great strides in his growth but still felt somewhat inadequate about himself as a man.  This was an important issue because he is in a field where he’s having to deal with macho types who are very successful. . .and very competitive.  There was one thing he said to me that I still remember:  when he gets up in the middle of the night to urinate, he sits on the toilet rather than standing because he then doesn’t have to wake up completely   Why was this an important message to me?  Because he said it to me in a somewhat halting, hesitant way.  I realized later that he was probably feeling uneasy because this is what females do.  I think if I had explored his discomfort at the time, we could have gotten more fully into his feelings of not being manly enough and dealt more effectively with that important issue.

Many years ago I had in therapy with me a fine woman who I learned, to my shock, was occasionally physically abused by her husband.  I dealt with that issue totally inadequately, wondering aloud why she stayed in the marriage, and she soon terminated.  This was, of course, before spousal abuse  became so well documented and the tremendous difficulties women have in leaving their abusers became understood.  I am sure that my reaction made her feel ashamed, an emotion she was already too consumed by.

Although I don’t think I have resolved my dilemma about the unfinished business I have with clients after they leave treatment, I have thought of one solution.  I realize I can take the advice I give clients during our last session.  I ask them to imagine they have left and to see if there is  anything they wish they had said to me, i.e., unfinished business they might have.  I think I might take my own advice and say  to them:  “I have really liked working with you and, if you feel like doing so, feel free to drop me a line, letting me know how you are doing.  I would appreciate that.    No pressure; just if you feel like doing so.”